The authors suggest that occlusion of blood flow to the whole liver is not necesarily a routine procedure in surgical removal of giant cavernous hemangioma in the 8th segment of liver. An occlusion tape can be placed around the finferior vena cava inadvance. Separtion of inferior vena cava between the diaphragm and the upper surface of liver sometimes is difficult, so that placement of the tape may fail. The procedure which we performed in four patients was intermittent occlusion of blood flow at the first hepatic hilum at room temperature during dissection and removal of the tumor en bloc. This operative method is simple and safe as compared with that of resection of the 8th segment of liver.
Plasma cortisols in 18 abdominal emergency patients and 20 planned-operation patients were examined. The result showed that cortisols in planned-operation patients were increased after their operations. On the other hand, plasma cortisols in emergency patients were higher in preoperative period than that in the postoperative period. There were no furher increase after operations. The changes of plasma cortisols between two kinds of patients were very different. This means that stress reactions in the patient with acute abdomen can be reduced by early operations.
Objective To provide a reliable experimental model for gastroesophageal reflux (GER) study. Methods Twenty Japan 5-month-old male rabbits wererandomly divided into two groups: group cardiomyotomy(n=10), group partial cardiomyectomy(n=10). The operations of cardiomyotomy and parital cardiomyectomy were performed in 2 groups respectively. All the animals underwent intraesophagealpH detection 1 week before operation and 4 weeks after operation. The mean changes of reflux ratios were compared between before operation and after operation.Results In gastroesophageal reflux ratio between before operation and after operation, there was no significant difference in group cardiomyotomy (1.98%±1.52% and 4.32%±2.39%, Pgt;0.05) and there was significant difference in group partialcardiomyectomy（1.56%±1.57% and 13.56%±3.27%, Plt;0.05）. Conclusion The reliable experimental model of GER can be made with procedure of partial cardiomyectomy. It can be used in estimating the operative procedure of antireflux and is conducive to dynamic observation and study of esophagitis.
Objective
To summarize the characteristics of surgery-related near misses including events composition, cause of incident, specialty category, personnel allocation etc, and to provide experience of feedforward control for the nurses in operating room and a clinical basis of safety standards for the management of operating rooms.
Method
The 240 surgery-related near misses occurred between July 2014 and July 2016 were retrospectively analyzed, using frequencies and percentiles to describe the count data.
Results
The 240 surgery-related near misses were mainly associated with surgical stitches (91 cases, 37.9%), surgical dressings (52 cases, 21.7%) and surgical instruments (45 cases, 18.8%). The main features of the 91 cases of surgical stitching included loss of suture needles (40.7%, 37/91) and fracture events (37.4%, 34/91). Among the 52 cases of surgical dressings, the most commonly were gauze dressing events (43 cases, 82.7%), in which 19 were with unclear numbers of retained gauzes in the reoperation patient’s body, and 15 were postoperative counting anomalies. Among the 45 cases of surgical instruments, the fracture and defect were the most common (21 cases, 46.7%).
Conclusion
The operation nurses should focus on the prevention of suture needle loss, the surgical dressings loss and the fracture and defect of surgical instruments, etc, to reduce or avoid the surgery-related near misses.
Objective
To evaluate the radical chemoradiotherapy plus surgery for locally advanced cervical patients.
Methods
102 cases of patients with locally advanced cervical cancer were randomly divided into a trial group and a control group. In the control group, patients received radical chemoradiotherapy only, with chemotherapy consisted of cisplatin 35-40 mg/m2, one times a week. In the trial group, patients received both treatment in the control group and extensive hysterectomy and pelvic lymph node dissection.
Results
Fifty-two patients were randomly enrolled into the trial group and 50 patients into the control group. The microscopic residual tumor (MRT) rate was 5.8% (3/52) and non-microscopic residual tumor (NMRT) rate was 82.7% (43/52) in the trial group. Progression-free survival time was 3-40 months with a median survival time of 23 months, and the 3-year progression-free survival rate was 73.1% in the trial group, and progression-free survival time was 5–41 months with a median survival time of 22 months, and the 3-year progression-free survival rate was 64.8% in the control group; while the difference was not statistically significant (χ2=0.092,P=0.761). Overall survival time was 6–40 months with median overall survival time of 23 months, and the 3-year overall survival rate was 82.7% in the trial group, and overall survival time was 5-41 months with a median survival time of 22.5 months, and the 3-year overall survival rate was 81.8%; while the difference was not statistically significant (χ2=0.338,P=0.561).
Conclusion
Concomitant chemoradiation followed by radical surgery could not significantly improve progression-free survival and overall survival in patients with locally advanced cervical cancer. The treatment regimen should be applied with caution and selectivity.
Objective To study the clinicopathologic features which influence the prognosis of patients with stage Ib nonsmall cell lung cancer (NSCLC) after operation, and discuss the indication of postoperative chemotherapy. Methods From January 2002 to December 2002, the clinical materials of 152 patients who underwent complete pulmonary lobectomy and were confirmed to have stage Ib NSCLC by postoperative histopathological examination were collected from Shanghai Chest Hospital. There were 82 male and 70 female cases aged from 33-80 years. The mean age was 63.0 years. KaplanMeier method was used to compare and analyze the age, gender, tumor diameter, tumor location, lymphatic or vascular carcinoma embolus, differentiation, pleural invasion and chemotherapy of patients. Cox regression model was used to do prognostic multivariate analysis to above factors. Results The 5year survival rate was 71.1%. The median survival time was 44.20 months. The results of single factor analysis showed that the tumor diameter was longer than 5 cm（χ2=4.020，P=0.042）, lymphatic or vascular carcinoma embolus existed（χ2=14670，P=0.001）, poorly differentiated tumor（χ2=8.395，P=0.004）, and those whose tumors were located on middlelower lobars had a poor prognosis（χ2=3.980，P=0.045）. The age(χ2=0.478，P=0.740), gender(χ2=0.571，P=0.450), pathological type(χ2=0.406，P=0.816), pleural invasion(χ2=0.022，P=0.882) and postoperative chemotherapy of patients (χ2=1.067，P=0.302)had no relationship with postoperative survival. The results of multivariate analysis showed that lymphatic or vascular carcinoma embolus（P=0.006，95%CI:1.491,10.524） and poorly differentiated tumor（P= 0.001,95%CI:0.116,0.578） were the main factors which influenced the survival rate of patients. Conclusion The tumor differentiation and lymphatic or vessel carcinoma embolus of patients with stage Ib NSCLC are important factors which influence prognosis and survival rate. The poorly differentiated tumor and lymphatic or vessel carcinoma embolus could be regarded as one of the indications of postoperative chemotherapy.
【Abstract】 Objective To summarize the experience in radical excision of carcinoma of head of pancreas in order to improve the surgical skills and reduce the occurrence of postoperative complications. Methods The clinical material of 55 patients (ages: 32-72 years; mean age: 56.5 years) with carcinoma of head of pancreas who received radical excision from January 1996 to March 2005 were analyzed retrospectively. All the cases were pathologically verified as ductal adenocarcinoma of head of pancreas. The treatment time following the operations was divided into two phases by year 2002 ( phaseⅠ: 1996-2002; phaseⅡ: 2002-2005). Different surgical treatment groups were fixed and ICU and other measures were implemented during the second phase. Results All the patients, consisting of 31 males and 24 females, underwent consecutive extended resection. The radically curative rates of phaseⅠand phaseⅡ were 25.9%(29/112) and 34.7%(26/75), respectively, and the complication rates were 48.3%（14/29） and 19.2%（5/26）, respectively. A variety of surgical skills would improve the operation, including extended regional lymphadenectomy, resection of involved nerve plexus, combined vessel resection and comprehensive bleeding-control technique and so on. Conclusion The improvement of radically curative effect and the reduction of complication rate depend on the advancement of surgical skills and the further understanding of pathophysiology of carcinoma of head of pancreas.
Transcatheter aortic valve replacement (TAVR) has been a crucial treatment for elder patients with aortic stenosis in developed countries, which is still at its beginning in China. TAVR is a risky and complicated technic; and to promise the long-term development of it, we need to build a multiple disciplinary heart team consisted of doctors from different specialties and guided by various disciplines, also to guarantee the team operates well. In order to help Chinese doctors understand heart team well, this article describes component parts and requirement for each member of the team, in aspect of cardiologist, cardiac surgeon, echocardiologist, radiologist, anesthesiologist and nursing team; and discuss team operation mechanism through pre-procedural evaluation, procedural cooperation, peri-procedural management and post-procedural follow-up.
【Abstract】 Objective To explore the midterm efficacy of superelastic cage implantation for the treatment of osteonecrosisof femoral head (ONFH). Methods From July 1996 to January 1998, 54 patients (75 hips) of ONFH were treatedwith superelastic cage and followed up. Among 54 patients, 5 patients were lost to follow up and 3 patients were dead of myocardialinfarction, renal failure and gastric cancer, respectively. Forty-six patients completed follow up including 32 males and14 females, aged from 21 to 61 with an average of 39 years old. Twenty-nine hips were classified as Ficat Stage Ⅱ and 36 as StageⅢ . Harris score was 58.20 ± 13.82. All patients were evaluated both cl inically and radiographically. Results Postoperatively,forty-six patients (65 hips) were followed up for 86 to 125 months with an average of 8 years and 8 months. Harris score was 80.78 ± 18.77. Twenty-nine hips were rated excellent, 21 good, 2 fair and 13 poor．A total of 76.9% of overall cl inical results were rated as good or excellent. Eight hips (12.3%) with the cage broken were turned to total hip replacement. Radiographicevaluation: 16 hips (24.6%) rated as grade Ⅰ , 34 (52.3%) grade Ⅱ and 15 (23.1%) grade Ⅲ . Conclusion Superelastic cage implantation is one of alternative treatments for ONFH at early and midterm stages. However, long-term follow-up is needed to know whether it is able to cure ONFH and whether cages will be broken as time passes by.
Objective To explore surgical technique and clinical outcome of transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal hernia repair (TEP) in inguinal hernia repair. Methods 〗The clinical data of 23 patients underwent laparoscopic herniorrhaphy were retrospectively analyzed. Nine patients were underwent TAPP, and 14 patients underwent TEP. Results 〗None of patients was changed to open operation. Only one patient of TEP was changed to TAPP. Average operative time was (82.1±40.6) min. Blood loss was (5.7±3.0) ml. Disruption of peritoneum happened to 2 patients underwent TEP. The rate of postoperative complications was 21.7% (5/23), which included serum swelling (1 case), scrotal emphysema (2 cases), transient neurapraxia in the area of repair (1 case) and urinary retention (1 case). No chronic pain, foreign body sensation and infection were found. Average hospitalization after operation was (4.3±0.9) d. No recurrence was observed during a follow-up period of 1-15 months. Conclusion 〗Laparoscope herniorrhaphy is safe due to lower recurrence and complications. It also has the advantages of slight pain and rapid recovery.
